Diagnostic value of cardiopulmonary exercise test in differentiating physical deconditioning from post-pulmonary thromboembolism syndrome through clinical-paraclinical correlations
Keywords:
cardiopulmonary exercise testing, pulmonary embolism, physical deconditioningAbstract
Post-pulmonary embolism syndrome (PPES) affects the quality of life of survivors of acute pulmonary thromboembolism (PE), manifesting as persistent dyspnea. Differential diagnosis between pulmonary vascular sequelae and physical deconditioning requires non-invasive methods such as cardiopulmonary exercise testing (CPET). The aim was to assess the diagnostic value of CPET in differentiating PPES from physical deconditioning. A prospective, comparative study was performed, including 53 post-PE patients and 47 patients with persistent dyspnea but without prior PE; all subjects underwent clinicalparaclinical evaluation and CPET on cycloergometer. CPET identified three distinct functional profiles at 3-6 months post-event, accurately differentiating a 15-20% segment at high risk of chronic pulmonary hypertension from patients with predominant physical deconditioning. CPET proved useful for the functional triage of post-PE patients, providing superior diagnostic value in identifying residual vascular mechanisms versus physical deconditioning.
References
1. Humbert, M., Kovacs, G., Hoeper, M.M., et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022;43(38):3618-3731. https://doi.org/10.1093/eurheartj/ehac237
2. Diaconu, N., et al. Post-pulmonary embolism syndrome: long-term complications of pulmonary embolism. Moldovan Medical Journal. 2023;66(1):44-51. https://doi.org/10.52418/moldovan-med-j.66-1.23.08
3. Luijten, D., de Jong, C.M.M., Ninaber, M.K., et al. Post-Pulmonary Embolism Syndrome and Functional Outcomes after Acute Pulmonary Embolism. Seminars in Thrombosis and Hemostasis. 2023;49(8):848-860. https://doi.org/10.1055/s-0042-1749659
4. Kirchberger, I., Fischer, S., Berghaus, T.M., et al. Dyspnea after a first episode of pulmonary embolism: prevalence, predictors and long-term associations with health-related quality of life. Frontiers in Cardiovascular Medicine. 2025;12:1595705. https://doi.org/10.3389/fcvm.2025.1595705
5. Farmakis, I.T., Keller, K., Barco, S., et al. From acute pulmonary embolism to post-pulmonary embolism sequelae. VASA. 2022;52(1):29-37. https://doi.org/10.1024/0301-1526/a001042
6. Morris, T., Fernandes, T., Channick, R. Evaluation of dyspnea and exercise intolerance after acute pulmonary embolism. Chest. 2023;163(4):933-941. https://doi.org/10.1016/j.chest.2022.06.036
7. Shah, K.P., Lee, C., McBane, R.D., et al. Post-Pulmonary Embolism Syndrome - A Diagnostic Dilemma and Challenging Management. Mayo Clinic Proceedings. 2024;99(12):1965-1982. https://doi.org/10.1016/j.mayocp.2024.07.008
8. Alblas, H., van Kan, C., van het Westeinde, S.C., et al. Persistent dyspnea after acute pulmonary embolism is related to perfusion defects and lower long-term quality of life. Thrombosis Research. 2022;219:89-94. https://doi.org/10.1016/j.thromres.2022.09.008
9. Vanaken, G., Wieczorek, D., Rubick, D., et al. Cardiopulmonary exercise testing following acute pulmonary embolism: systematic review and pooled analysis of global studies. Pulmonary Circulation. 2024;14(4):e12451. https://doi.org/10.1002/pul2.12451
10. Mounsey, L.A., et al. Cardiopulmonary exercise testing in people with persistent dyspnea after pulmonary embolism. Annals of the American Thoracic Society. 2023;20(10):1528-1530. https://doi.org/10.1513/AnnalsATS.202302-108RL
11. Khilzi, K., Piccari, L., Franco, G., et al. Cardiopulmonary exercise testing with simultaneous echocardiography after pulmonary embolism. Pulmonary Circulation. 2025;15(1):e70045. https://doi.org/10.1002/pul2.70045
12. Mali, R.M.A., Ninaber, M.K., van Mens, T.E., et al. Key elements of follow-up care after acute pulmonary embolism focusing on long-term sequelae: a Delphi study among European experts. European Heart Journal. Quality of Care & Clinical Outcomes. 2025;11(7):1137-1143. https://doi.org/10.1093/ehjqcco/qcaf053
13. Farmakis, I.T., Valerio, L., Barco, S., et al. Follow-up algorithm for detecting chronic sequelae of pulmonary embolism: diagnostic performance and possible limitations. Journal of Thrombosis and Haemostasis. 2025;23(12):S1538-7836(25)00912-2. https://doi.org/10.1016/j.jtha.2025.11.029
14. Coquoz, N., Stolz, D., Popov, V., et al. Patient characteristics associated with dyspnea after an acute pulmonary embolism. European Respiratory Journal. 2025;66(suppl 69):PA1934. https://doi.org/10.1183/13993003.congress-2025.PA1934
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
